Healthcare Provider Details

I. General information

NPI: 1902080914
Provider Name (Legal Business Name): AFFINITY CARE PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 N. PINE STREET STE.C
GRAMERCY LA
70052
US

IV. Provider business mailing address

P O BOX 580
GRAMERCY LA
70052
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-6005
  • Fax: 225-869-6007
Mailing address:
  • Phone: 225-869-6005
  • Fax: 225-869-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1720739
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. STARLETTE SABRINA GORDON
Title or Position: ADM.
Credential:
Phone: 225-869-6005